TOPLINE:

Older age was linked to a significant reduction in functional recovery from baseline to 1 year after spinal cord injury (SCI), particularly in those older than 70 years; however, neurologic recovery was not associated with age.

METHODOLOGY:

• Researchers conducted a prospective observational cohort study using data from the European Multicenter Study about Spinal Cord Injury (EMSCI) to evaluate the association between age and neurologic and functional recovery after SCI and to identify an age cutoff associated with a decline in recovery.
• They included 2171 patients with traumatic and ischaemic SCI (mean age at injury, 46.4 years; 77.9% men; 51.9% with a cervical injury and 50.0% with a motor complete injury) from the EMSCI between 2001 and 2022.
• Primary outcomes were changes in the Spinal Cord Independence Measure (SCIM) total score and total motor score (TMS) from baseline to 1 year after SCI. Secondary outcomes included changes in sensory scores and ambulation parameters.
• An age cutoff was identified to assess the association between age and changes in functional recovery after SCI.

TAKEAWAY:

• Functional recovery measured using the SCIM declined with age (P < .001), with an estimated reduction in the total SCIM score of 4.3 points per decade of age; however, neurologic recovery, measured by changes in the TMS, did not show any significant association.
• An age-related significant reduction in ambulation parameters, such as 6-minute walking test, 10-m walking test, and walking index for SCI, was observed (P < .05 for all); however, sensory scores for light-touch and pinprick remained unaffected.
• A cutoff age of 70 years was identified, beyond which functional recovery after SCI declined markedly.

IN PRACTICE:

"Our study provides an estimation of the effect of age on neurologic and functional outcomes and for the first time a reliable cutoff age for functional decline after SCI," the authors wrote.

"These findings could positively influence the design of future clinical trials evaluating the efficacy of new pharmacologic, cell-based, and rehabilitative approaches for patients with SCI," they added.

SOURCE:

This study was led by Chiara Pavese, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, and Giorgio Scivoletto, Unit 1 and Spinal Cord Unit, IRCCS Fondazione S. Lucia, Rome, both in Italy. It was published online on December 23, 2025, in Neurology.

LIMITATIONS:

The considerable number of patients lost to follow-up at 1 year, and reasons for loss to follow-up and mortality data were lacking. This study did not account for age-related factors such as comorbidities, psychological status, and cognitive decline, which could have influenced functional recovery. Data on early surgical management could not be captured because data collection started only after patients were transferred from primary care hospitals.

DISCLOSURES:

This study received support from the Swiss National Science Foundation, Wings for Life Research Foundation, and Swiss State Secretariat for Education, Research and Innovation. This study was funded by the European Union's Horizon 2020 research and innovation program. One author was supported by the International Foundation for Research in Paraplegia.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.